Orthognathic Hardware Complications in the Era of Patient-Specific Implants

Abstract

Background: Patients undergoing orthognathic skeletal correction present with a variety of comorbidities that may affect surgical outcomes. The purpose of this study was to determine how patient risk factors and operative technique contribute to complication rates after orthognathic surgery in the era of patient-specific implants. Methods: Retrospective cohort analysis was conducted of pediatric patients undergoing Le Fort I osteotomy, bilateral sagittal split osteotomy, and/or genioplasty from 2014 to 2018. Patient risk factors, operative characteristics, and postoperative outcomes were gathered and compared with appropriate statistics. Results: Ninety-four patients met inclusion criteria, with an overall 1-year complication rate of 11.7 percent (11 of 94). Patient-specific mandibular plates are significantly associated with infection (p = 0.009; OR, 8.8), occurrence of any complication (p = 0.003; OR, 8.3), readmission (p < 0.001; OR, 11.1), and reoperation (p < 0.001; OR, 11.4). In patients with syndromes or history of cleft lip/palate, patient-specific mandibular plates are associated with infection (p = 0.006; OR, 10.3), readmission (p < 0.001; OR, 21.6), and reoperation (p < 0.001; OR, 22.9). In multivariate regression controlling for age, sex, syndrome status, and orofacial cleft history, use of patient-specific mandibular plates was associated with infection (p = 0.017; adjusted OR, 12.5), any complication (p = 0.007; adjusted OR, 11.8), readmission (p = 0.001; adjusted OR, 17.9), and reoperation (p = 0.001; adjusted OR, 18.9). Conclusions: In the era of patient-specific orthognathic surgery, syndromic status and use of patient-specific mandibular plates are associated with increased infection, readmission, and reoperation because of hardware-related complications. The authors’ data support increased caution and counseling with use of patient-specific mandibular implants in patients with syndromic status, history of orofacial cleft, and history of previous maxillomandibular surgery given increased risk of hardware-related complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Pediatric Orthognathic Surgery: National Analysis of Perioperative Complications

“…In this first look at a nationwide cohort of children undergoing orthognathic surgery, we found a perioperative adverse event rate of 7.8%, which were associated with having any comorbidity, overall respiratory comorbidities, structural pulmonary abnormality, developmental delay, structural central nervous system abnormality, and neuromuscular disorder. Our complication rate is comparable to single-institution studies of pediatric populations at 11.7%, 9 and falls within the wide range of complications between 4% and 27% in the adult literature. 2,8,[10][11][12][13][14][15][16] Much of this range is likely due to inconsistent reporting, 2 which may be mitigated by utilizing a standardized national database.…”

“…Previous study of orthognathic surgery in children demonstrated that surgical site infections are the most common complication at 5.3%, which all occurred at the mandible. 9 Hemorrhagic complications after orthognathic surgery in adult patients have been cited between 0.8% and 11.1%, 2,5,10,13 -15 such that preoperative autogenous blood donation is offered by some institutions before surgery. 10 Double-jaw procedures were not more likely to develop hematomas or significant bleeding requiring transfusion; however, presence of any comorbidity was significantly associated with a hemorrhagic complication in pediatric patients undergoing orthognathic surgery (P < 0.001).…”

“…0.130), which is supported by a single-center investigation on pediatric patients undergoing orthognathic surgery at a high-volume center. 9 Length of stay after orthognathic surgery has been demonstrated to be significantly longer overall for pediatric patients than adult patients. 8 Length of stay in pediatric patients was not significantly longer for double-jaw procedures (P ¼ 0.968).…”

“…6,7 Yet, it is hard to find a single ideal material for all cranioplasties that manage functional and aesthetic indications at the same time. 8,9 Judiciously, a staged approach can suffice the reconstruction requirements for such temporal defects. In our study, a staged approach is proposed, where stage I included…”

Simultaneous PSI-Based Orthognathic and PEEK Bone Augmentation Surgery Leads to Improved Symmetric Facial Appearance in Craniofacial Malformations

“…Furthermore, despite all the advantages of the combined PSI-based orthognathic procedure with the additional placement of PEEK bone augmentations, the negative aspects should not be ignored. In particular, the insertion of foreign material carries a risk of infection [ 57 ]. However, this risk can be countered by appropriate antibiotic shielding measures [ 58 ].…”